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The Critical Characteristics of a Good Wheelchair Cushion

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Science and Practice of Pressure Ulcer Management

Abstract

In this chapter, the authors describe the key characteristics of effective wheelchair cushions. The novel use of finite element (FE) computational modeling is introduced, aimed at examining the efficacy of various wheelchair cushion designs and their ability to protect patients against sitting-acquired pressure ulcers (PUs) and deep tissue injuries (DTI). Fifty-four FE model variants describing a reference spinal cord injury (SCI) anatomy with the addition of pathoanatomical changes associated with SCI (e.g. considerable weight gain, muscular atrophy, scars in the soft tissues) were developed and simulated sitting on a flat foam cushion, a contoured foam cushion or an air-cell-based cushion. Sufficient immersion and envelopment of the body were identified as key factors, which together represent the potential cushioning performance of a cushion, through minimization of internal tissue deformations, strains and stresses. A good wheelchair cushion should be able to accommodate the seated buttocks while providing the appropriate immersion and envelopment, during the entire time of intended use. Adjustability is another key factor, as the cushion has to be able to accommodate changes in posture and weight shifts associated with daily living, and conform to the remarkable disuse-related anatomical and physiological changes, which are expected in the months and years following a SCI. Furthermore, the cushion should maintain its physical and mechanical properties as well as its performance over time and despite exposure to various degenerating conditions, which can be expected during the lifespan of a wheelchair cushion. Given the recent advancements in understanding the aetiology of PUs and the availability of novel tools and research methodologies to assess wheelchair cushion efficacies, there is still a considerable gap between public policy and the current practice in cushion evaluation, and the challenges and measures that should be applied.

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References

  1. Gefen A. The biomechanics of sitting-acquired pressure ulcers in patients with spinal cord injury or lesions. Int Wound J. 2007;4:222–31.

    Article  PubMed  Google Scholar 

  2. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. In: Emily Haesler, editor. Osborne Park, Western Australia: Cambridge Media; 2014.

    Google Scholar 

  3. Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C, Stubbs N, Farrin A, Dowding D, Schols JM, Cuddigan J, Berlowitz D, Jude E, Vowden P, Schoonhoven L, Bader DL, Gefen A, Oomens CW, Nelson EA. A new pressure ulcer conceptual framework. J Adv Nurs. 2014;70(10):2222–34.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Coleman S, Gorecki C, Nelson EA, Closs SJ, Defloor T, Halfens R, Farrin A, Brown J, Schoonhoven L, Nixon J. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. 2013;50(7):974–1003.

    Article  PubMed  Google Scholar 

  5. Pieper B, National Pressure Ulcer Advisory Panel, editors. Pressure ulcers: prevalence, incidence and implications for the future. Washington: NPUAP; 2012.

    Google Scholar 

  6. VanGilder C, Macfarlane GD, Meyer S. Results of nine international pressure ulcer prevalence surveys: 1989 to 2005. Ostomy Wound Manage. 2008;54(2):40–54.

    PubMed  Google Scholar 

  7. Chan BC, Nanwa N, Mittmann N, Bryant D, Coyte PC, Houghton PE. The average cost of pressure ulcer management in a community dwelling spinal cord injury population. Int Wound J. 2013;10(4):431–40.

    Article  PubMed  Google Scholar 

  8. Duncan KD. Preventing pressure ulcers: the goal is zero. Jt Comm J Qual Patient Saf. 2007;33(10):605–10.

    Article  PubMed  Google Scholar 

  9. Allman RM, Goode PS, Burst N, Bartolucci AA, Thomas DR. Pressure ulcers, hospital complications, and disease severity: impact on hospital costs and length of stay. Adv Wound Care. 1999;12(1):22–30.

    PubMed  CAS  Google Scholar 

  10. Gorecki C, Brown JM, Nelson EA, Briggs M, Schoonhoven L, Dealey C, Defloor T, Nixon J. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc. 2009;57(7):1175–83.

    Article  PubMed  Google Scholar 

  11. Spilsbury K, Nelson A, Cullum N, Iglesias C, Nixon J, Mason S. Pressure ulcers and their treatment and effects on quality of life: hospital inpatient perspectives. J Adv Nurs. 2007;57(5):494–504.

    Article  PubMed  Google Scholar 

  12. Raghavan P, Raza WA, Ahmed YS, Chamberlain MA. Prevalence of pressure sores in a community sample of spinal injury patients. Clin Rehabil. 2003;17(8):879–84.

    Article  CAS  PubMed  Google Scholar 

  13. Garber SL, Rintala DH, Hart KA, Fuhrer MJ. Pressure ulcer risk in spinal cord injury: predictors of ulcer status over 3 years. Arch Phys Med Rehabil. 2000;81(4):465–71.

    Article  CAS  PubMed  Google Scholar 

  14. Carda S, Cisari C, Invernizzi M. Sarcopenia or muscle modifications in neurologic diseases: a lexical or pathophysiological difference? Eur J Phys Rehabil Med. 2013;49:119–30.

    PubMed  CAS  Google Scholar 

  15. Scott JM, Warburton DE, Williams D, Whelan S, Krassioukov A. Challenges, concerns and common problems: physiological consequences of spinal cord injury and microgravity. Spinal Cord. 2011;49:4–16.

    Article  CAS  PubMed  Google Scholar 

  16. Castro MJ, Apple DF Jr, Staron RS, Campos GE, Dudley GA. Influence of complete spinal cord injury on skeletal muscle within 6 month of injury. J Appl Phys. 1999;86:350–8.

    CAS  Google Scholar 

  17. Giangregorio L, McCartney N. Bone loss and muscle atrophy in spinal cord injury: epidemiology, fracture prediction, and rehabilitation strategies. J Spinal Cord Med. 2006;29:489–500.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Shaw CS, Clark J, Wagenmakers AJ. The effect of exercise and nutrition on intramuscular fat metabolism and insulin sensitivity. Annu Rev Nutr. 2010;30:13–34.

    Article  CAS  PubMed  Google Scholar 

  19. Zehnder Y, Luthi M, Michel D, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men. Osteoporos Int. 2004;15(3):180–9.

    Article  PubMed  Google Scholar 

  20. de Bruin ED, Herzog R, Rozendal RH, Michel D, Stussi E. Estimation of geometric properties of cortical bone in spinal cord injury. Arch Phys Med Rehabil. 2000;81:150–6.

    Article  PubMed  Google Scholar 

  21. Rittweger J, Gerrits K, Altenburg T, Reeves N, Maganaris CN, de Hann A. Bone adaptation to altered loading after spinal cord injury: a study of bone and muscle strength. J Musculoskelet Neuronal Interact. 2006;6:269–76.

    PubMed  CAS  Google Scholar 

  22. Linder-Ganz E, Shabshin N, Itzchak Y, Yizhar Z, Siev-Ner I, Gefen A. Strains and stresses in sub-dermal tissues of the buttocks are greater in paraplegics than in healthy during sitting. J Biomech. 2008;41:567–80.

    Article  PubMed  Google Scholar 

  23. Cox SA, Weiss SM, Posuniak EA, Worthington P, Prioleau M, Heffley G. Energy expenditure after spinal cord injury: an evaluation of stable rehabilitating patients. J Trauma. 1985;25:419–23.

    Article  CAS  PubMed  Google Scholar 

  24. Crane DA, Little JW, Burns SP. Weight gain following spinal cord injury: a pilot study. J Spinal Cord Med. 2011;34:227–32.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Chen Y, Henson S, Jackson AB, Richards JS. Obesity intervention in persons with spinal cord injury. Spinal Cord. 2006;44:82–91.

    Article  CAS  PubMed  Google Scholar 

  26. Levy A, Kopplin K, Gefen A. Simulations of skin and subcutaneous tissue loading in the buttocks while regaining weight-bearing after a push-up in wheelchair users. J Mech Behav Biomed Mater. 2013;28:436–47.

    Article  PubMed  Google Scholar 

  27. Levy A, Kopplin K, Gefen A. An air-cell-based cushion for pressure ulcer protection remarkably reduces tissue stresses in the seated buttocks with respect to foams: finite element studies. J Tissue Viability. 2014;23(1):13–23.

    Article  PubMed  Google Scholar 

  28. Levy A, Kopplin K, Gefen A. Computer simulations of the efficacy of air-cell-based cushions in protecting against reoccurrence of pressure ulcers. J Rehabil Res Dev. 2014;51(8):1297–319.

    Article  PubMed  Google Scholar 

  29. Shoham N., Levy A, Kopplin K, Gefen A. Contoured foam cushions cannot provide long-term protection against pressure ulcers for individuals with a spinal cord injury: modeling studies. Adv Skin Wound Care. 2014.

    Google Scholar 

  30. Simpleware® Ltd. ScanIP, +FE, +NURBS and +CAD Reference Guide ver. 5.1, 2012. http://www.simpleware.com/software/.

  31. Sopher R, Nixon J, Gorecki C, Gefen A. Effects of intramuscular fat infiltration, scarring, and spasticity on the risk for sitting-acquired deep tissue injury in spinal cord injury patients. J Biomech Eng. 2011;133(2):021011.

    Article  PubMed  Google Scholar 

  32. National Guideline Clearinghouse (NGC). Guideline synthesis: Prevention of pressure ulcers. In: National Guideline Clearinghouse (NGC) [http://www.guideline.gov/syntheses/printView.aspx?id=25078]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Dec (revised 2011 Jan). http://www.guideline.gov. Accessed 20 Oct 2013.

  33. Maas SA, Ellis BJ, Ateshian GA, Weiss JA. FEBio: finite elements for biomechanics. J Biomech Eng. 2012;134(1):5–11.

    Article  Google Scholar 

  34. Wheelchair seating, ISO/TC 173/SC 1/WG 11, 2014.

    Google Scholar 

  35. ISO 16840–12 “Wheelchair Seating—Part 12 Apparatus and Method for Cushion Envelopment Testing”.

    Google Scholar 

  36. Oomens CWJ, Bressers OFJT, Bosboom EMH, Bouten CVC, Bader DL. Can loaded interface characteristics influence strain distributions in muscle adjacent to bony prominences? Comput Methods Biomech Biomed Engin. 2003;3:171–80.

    Article  Google Scholar 

  37. Shabshin N, Zoizner G, Herman A, Ougortsin V, Gefen A. Use of weight-bearing MRI for evaluating wheelchair cushions based on internal soft-tissue deformations under ischial tuberosities. J Rehabil Res Dev. 2010;47:31–42.

    Article  PubMed  Google Scholar 

  38. Gefen A. Tissue changes in patients following spinal cord injury and implications for wheelchair cushions and tissue loading: a literature review. Ostomy Wound Manage. 2014;60(2):34–45.

    PubMed  Google Scholar 

  39. Sprigle S, Delaune W. Factors that influence changes in wheelchair cushion performance over time. Assist Technol. 2014;26(2):61–8.

    Article  PubMed  Google Scholar 

  40. Ferguson-Pell MW. Technical considerations: seat cushion selection. J Rehabil Res Dev Clin Suppl. 1998;(2):49–73. (Fourth Printing: March).

    Google Scholar 

  41. ISO 16840–6. “Wheelchair Seating—Part 6. Determination of the changes in properties following simulated extended use—Seat cushions”.

    Google Scholar 

  42. Sprigle S, Press L, Davis K. Development of uniform terminology and procedures to describe wheelchair cushion characteristics. J Rehabil Res Dev. 2001;38(4):449–61.

    PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel

    Ayelet Levy, Naama Shoham & Amit Gefen

  2. Efficacy Research, Standards and Compliance, ROHO, Inc, Belleville, IL, USA

    Kara Kopplin

Authors
  1. Ayelet Levy
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  2. Naama Shoham
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  3. Kara Kopplin
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  4. Amit Gefen
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Corresponding author

Correspondence to Amit Gefen .

Editor information

Editors and Affiliations

  1. Department of Dermatology, Santa Chiara Hospital, University of Pisa, Pisa, Italy

    Marco Romanelli

  2. Welsh Wound Innovation Centre, Rhondda Cynon Taf Wales, United Kingdom

    Michael Clark

  3. Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University, Tel Aviv, Israel

    Amit Gefen

  4. Bambino Gesuʼ Childrenʼs Hospital, Rome, Italy

    Guido Ciprandi

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Levy, A., Shoham, N., Kopplin, K., Gefen, A. (2018). The Critical Characteristics of a Good Wheelchair Cushion. In: Romanelli, M., Clark, M., Gefen, A., Ciprandi, G. (eds) Science and Practice of Pressure Ulcer Management. Springer, London. https://doi.org/10.1007/978-1-4471-7413-4_2

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  • DOI: https://doi.org/10.1007/978-1-4471-7413-4_2

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-7411-0

  • Online ISBN: 978-1-4471-7413-4

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